[The value of endoscopic retrograde cholangiopancreaticography for the surgery of bile duct and pancreatic diseases].

The value of endoscopic retrograde cholangiopancreaticography (ERCP) for establishing the indication for surgery and for planning surgical procedures is discussed. The two most widely practiced methods of direct cholangiography - percutaneous transhepatic and endoscopic retrograde cholangiography (PTC and ERC) - are compared: although the filling rate with ERC is slightly lower than with PTC, the endoscopic method has some important advantages as it allows endoscopic observation and biopsy of the duodenum. Furthermore, opacification of the pancreatic duct system often provides important additional information. ERCP is essentially important in post-cholecystectomy syndrome, as puncture of undilated bile ducts is difficult and persistent symptoms after cholecystectomy are not infrequently related to pancreatic disease. The importance of rapid surgical intervention after retrograde filling of the biliary tree in obstructive jaundice is stressed. In pancreatic diseases the indication for surgery is based mainly on clinical and laboratory findings. Differentiation of malignant and inflammatory changes in the pancreaticogram is still a problem. However, the contribution of ERCP to pancreatic surgery is very important, as it exactly localized lesions of the pancreas and therefore allows detailed planning of a surgical procedure. Stenosing or obstructing lesions often are an indication for surgery, even if their malignant nature is not certain, as severe pain in chronic pancreatitis may be relieved by surgery. The potential for therapeutic application of endoscopy in biliary and pancreatic diseases is briefly discussed.